Provider Demographics
NPI:1043519317
Name:NELSON, REBECCA (OTRL)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 SE BROOKSIDE DR APT 29
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-4158
Mailing Address - Country:US
Mailing Address - Phone:503-260-2230
Mailing Address - Fax:
Practice Address - Street 1:4601 SE BROOKSIDE DR APT 29
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-4158
Practice Address - Country:US
Practice Address - Phone:503-260-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR259153225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist